Predictive value of perioperative NT-proBNP levels for acute kidney injury in patients with compromised renal function undergoing cardiac surgery: a case control study

• Published in: BMC anesthesiology 2024-08, Vol.24 (1), p.298-12, Article 298
• Main Authors: Ma, Yiting, Zheng, Jili, Zhou, Wanting, Luo, Zhe, Jiang, Wuhua
• Format: Article
• Language: English
• Subjects: Acute kidney Injury; Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Aged; Analysis; Biomarkers; Biomarkers - blood; Brain natriuretic peptide; Canada; Cardiac function; Cardiac surgery; Cardiac Surgical Procedures - adverse effects; Care and treatment; Case-Control Studies; Chronic kidney failure; Coronary artery disease; Creatinine; Developmental stages; Diabetes; Diabetes mellitus; Epidermal growth factor receptors; Female; Health aspects; Heart diseases; Heart surgery; Hospital patients; Hospitals; Humans; Hypertension; Kidney diseases; Kidneys; Male; Medical research; Medicine, Experimental; Middle Aged; Morbidity; Mortality; Natriuretic Peptide, Brain - blood; Natriuretic peptides; NT-proBNP; Patients; Peptide Fragments - blood; Peptides; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Predictive Value of Tests; Regression analysis; Renal function; Retrospective Studies; Risk assessment; Risk factors; Statistical analysis; Surgery; Urine; Variables
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-024-02672-w

Acute kidney injury (AKI) significantly increases morbidity and mortality following cardiac surgery, especially in patients with pre-existing renal impairments. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and dysfunction, conditions often exacerbated during cardiac surgery and prevalent in chronic kidney disease (CKD) patients. Elevated NT-proBNP levels can indicate underlying cardiac strain, hemodynamic instability and volume overload. This study evaluated the association between perioperative changes in NT-proBNP levels and the incidence of AKI in this particular patient group. This retrospective study involved patients with impaired renal function (eGFR 15-60 ml/min/1.73 m²) who underwent cardiac surgery from July to December 2022. It analyzed the association between the ratio of preoperative and ICU admittance post-surgery NT-proBNP levels and the development of AKI and AKI stage 2-3, based on KDIGO criteria, using multivariate logistic regression models. Restricted cubic spline analysis assessed non-linear associations between NT-proBNP and endpoints. Subgroup analysis was performed to assess the heterogeneity of the association between NT-proBNP and endpoints in subgroups. Among the 199 participants, 116 developed postoperative AKI and 16 required renal replacement therapy. Patients with AKI showed significantly higher postoperative NT-proBNP levels compared to those without AKI. Decreased baseline eGFR and increased post/preoperative NT-proBNP ratios were associated with higher AKI risk. Specifically, the highest quantile post/preoperative NT-proBNP ratio indicated an approximately seven-fold increase in AKI risk and a ninefold increase in AKI stage 2-3 risk compared to the lowest quantile. The area under the receiver operating characteristic curve for predicting AKI and AKI stage 2-3 using NT-proBNP were 0.63 and 0.71, respectively, demonstrating moderate accuracy. Subgroup analysis demonstrated that the positive association between endpoints and logarithmic transformed post/preoperative NT-proBNP levels was consistently robust in subgroup analyses stratified by age, sex, surgery, CPB application, hypertension, diabetes status and fluid balance. Perioperative NT-proBNP level changes are predictive of postoperative AKI in patients with pre-existing renal deficiencies undergoing cardiac surgery, aiding in risk assessment and patient management.